2- Substance misuse Flashcards
Acute intoxication:
The acute, usually transient, effect of the substance.
Harmful use:
Recurrent misuse associated with physical, psychological and social consequences, but without dependence.
Dependence syndrome:
Prolonged, compulsive substance use leading to addiction, tolerance and the potential for withdrawal syndromes.
Withdrawal state:
Physical and/or psychological effects from complete (or partial) cessation of a substance after prolonged, repeated or high level of use.
Psychotic disorder:
Onset of psychotic symptoms within 2 weeks of substance use. Must persist for more than 48 hours.
Amnesic syndrome:
Memory impairment in recent memory (impaired learning of new material) and ability to recall past experiences. Also defect in recall, clouding of consciousness and global intellectual decline.
Residual disorder:
Specific features (flashbacks, personality disorder, affective disorder, dementia, persisting cognitive impairment) subsequent to substance misuse.
prevalence of substance misuse
M?F 3:1
- Cannabis most commonly consumed drug, used by 5% of the population
pathophysiology of substance misuses
Classes of drugs
- Opiates
- Cannabinoids
- Sedatives- hypnotics
- Stimulants
- Hallucinogens
- Anabolic steroids
complications of substance misuse
Substance misuse presentation with acronynm
DRUG PROBLEMS WILL CONTUNUE TO HARM >3 of the following manifestations
- (1) Strong Desire (compulsion) to consume substance;
- (2) Preoccupation with substance use.
- (3) Withdrawal state when substance ingestion is reduced or stopped;
- (4) Impaired ability to Control substance-taking behaviour (e.g. onset, termination or level of use);
- (5) Tolerance to substance, requiring more consumption for desired effect;
- (6) Persisting with use, despite clear evidence to the Harmful effects.
examples of opiates
e.g. morphine, diamorphine (heroin), codeine, methadone
routes of opiates
- Morphine- PO,IV
- Diamorphine – IN, IV, smoked
- Codeine/ methadone -PO
effects of opiates
1) Psychological
Apathy, disinhibition, psychomotor retardation, impaired judgement and attention, drowsiness, slurred speech
2) Physical
Respiratory depression, hypoxia, decreased BP, hypothermia, coma, pupillary constriction
withdrawal state of opiates
Withdrawal states (at least 3 signs needed)
Craving, rhinorrhoea, lacrimation, myalgia, abdominal cramps, N+V, diarrhoea, pupillary dilatation, piloerection, increased HR/ BP
Management of opioid dependence
- First line: methadone
- Or buprenorphine for detox and maintenance
- Naltrexone (recommended for those who were formerly opioid-dependent but have now stopped and are motivated)
Management of opioid overdose
- Intravenous naloxone (antidote)
overdose
- Growing problem
- Large number of iatrogenic addicts
- 1 in 4 will develop addiction
- 9.6% rise in drug related deaths 20162017
- 67.8% caused by opiates
how is opiate overdose mediated
- U (MOP) receptor
- As you take more and more you need to take more to get relief
- Variable effects of doses
- Main cause of death is resp depression- acidosis
- Naloxone= treatment
- Be a vigilant prescriber
cannabinoids example
cannabis
route of cannabinoids
PO or smoke
effects of cannabinoids
1) Psychological
Euphoria, disinhibition, agitation, paranoid ideation, temporal slowing (time passes slowly), impaired judgement/ attention/reaction time, illusions, hallucinations
2) Physical
Increased appetite, dry mouth, conjunctival injection, increased HR
withdrawal state of cannabinous
Withdrawal state (at least 3 signs needed)
Anxiety, irritability, tremor of outstretched hands, sweating, myalgia